Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Am J Gastroenterol. 2019 Aug;114(8):1248-1255. doi: 10.14309/ajg.0000000000000295.
Up to 20% of patients with refractory gastroesophageal reflux disease (GERD) might have postprandial rumination. The aim of this study was to distinguish persistent GERD-related postprandial regurgitation from rumination in patients with refractory GERD undergoing ambulatory multichannel intraluminal impedance-pH (MII-pH) monitoring.
We first characterized 24-hour and postprandial MII-pH patterns in 28 consecutive patients with confirmed rumination syndrome (positive clinical and high-resolution manometry/impedance). We compared such MII-pH patterns with those from 30 patients with typical GERD symptoms (10 nonerosive reflux disease, 10 hyperactive esophagus, and 10 functional heartburn) and 27 healthy controls. Using ROC curves, we selected the best MII-pH parameters to prepare an MII-pH rumination score. We prospectively tested the performance of the new MII-pH rumination score in 26 consecutive patients with refractory GERD (predominant regurgitation).
Compared with GERD controls, patients with rumination were more often females, younger, and had significantly more postprandial early nonacid reflux episodes with high proximal extent. Postprandial reflux in ruminators had a distinct nadir pH profile over time (from nonacid to acid). Despite increased reflux events, baseline impedance in ruminators was similar to that in healthy subjects. Ruminators marked postprandial symptoms earlier and much more often than patients with GERD. An MII-pH-based rumination score (using postprandial nonacid reflux/hour and Symptom Index) diagnosed rumination in 46% of patients with refractory GERD and persistent regurgitation (sensitivity 91.7% and specificity 78.6%).
Postprandial rumination is very common in refractory GERD with persistent regurgitation. A simple MII-pH score detects rumination in these patients with high sensitivity and specificity.
多达 20%的难治性胃食管反流病（GERD）患者可能存在餐后反刍。本研究旨在通过动态多通道腔内阻抗-pH（MII-pH）监测区分难治性 GERD 患者持续性 GERD 相关餐后反流与反刍。
我们首先对 28 例经证实存在反刍综合征（阳性临床和高分辨率测压/阻抗）的患者进行 24 小时和餐后 MII-pH 模式特征分析。我们将这些 MII-pH 模式与 30 例具有典型 GERD 症状的患者（非糜烂性反流病 10 例、食管过度活动症 10 例、功能性烧心 10 例）和 27 例健康对照进行比较。我们使用 ROC 曲线选择最佳的 MII-pH 参数来制定 MII-pH 反刍评分。我们前瞻性地在 26 例难治性 GERD （主要为反流）患者中测试了新的 MII-pH 反刍评分的性能。
与 GERD 对照组相比，反刍患者中女性更多，年龄更小，且餐后早期非酸性反流事件发生率更高，近端范围更大。反刍者餐后反流的 pH 值随时间逐渐下降（从非酸性到酸性）。尽管反流事件增加，但反刍者的基础阻抗与健康受试者相似。反刍者比 GERD 患者更早、更频繁地标记餐后症状。基于 MII-pH 的反刍评分（使用餐后非酸性反流/小时和症状指数）在 46%的难治性 GERD 伴持续性反流患者中诊断出反刍（敏感性为 91.7%，特异性为 78.6%）。
餐后反刍在难治性 GERD 伴持续性反流中非常常见。简单的 MII-pH 评分可在这些患者中以较高的敏感性和特异性检测出反刍。
